pivmecillinam hydrochloride
CLINICAL USE
Antibacterial agent
DOSE IN NORMAL RENAL FUNCTION
Acute uncomplicated cystitis: 400 mg initially, then 200 mg 3 times a dayChronic or recurrent bacteriuria: 400 mg every 6–8 hoursEnteric fever (typhoid): 1.2–2.4 g daily for 14 days
PHARMACOKINETICS
Molecular weight :476 %Protein binding :5–10 %Excreted unchanged in urine : 45–50 (as mecillinam) Volume of distribution (L/kg) :0.2–0.4 (as mecillinam)half-life – normal/ESRD (hrs) :1.2/Increased DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
20 to 50 : Dose as in normal renal function 10 to 20 : Dose as in normal renal function <10 : Dose as in normal renal function. See ‘Other Information’ DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD :Likely dialysability. Dose as in GFR <10 mL/min HD :Likely dialysability. Dose as in GFR <10 mL/minHDF/high flux :Likely dialysability. Dose as in GFR <10 mL/minCAV/VVHD :Likely dialysability. Dose as in normal renal function IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsMethotrexate: penicillins can reduce the excretion of methotrexate (increased risk of toxicity)Probenecid: reduces excretion of penicillins ADMINISTRATION
Reconstition
– Route
Oral Rate of Administration
–Comments
Take with food OTHER INFORMATION
Hydrolysed to mecillinam which is the active drug Contraindicated in carnitine deficiency as it can cause carnitine deficiencyCan cause oesophageal injury, take with water and food while standing upCan cause porphyria Accumulation may occur in patients with severe renal impairment, so use the lower dose if using for extended periods of timeUnlikely to work in people with little residual kidney function as works by renal excretion into the bladder, where its site of action
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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